Annex A Multi Year Assistance Program Proposal Application Format by epmd


									                                                            Annex A

                                Multi-Year Assistance Program Proposal Application Format

                                                      P.L. 480 Title II
                                                Country/Cooperating Sponsor

                                                        FY 06 – FY xx

                                               Multi-Year Assistance Program

                     Proposal Application Format

Resource Request Summary:

Activity Completion Date: ___________ 

Life of Activity Commodity Request (MT): ___________ 

Life of Activity Monetization Budget Request (US$ Equiv.): ___________ 

Life of Activity Section 202(e) Budget Request (US$): ___________ 

Life of Activity ITSH Budget Request (US$): ___________ 

       Date of Submission to USAID/Mission and DCHA/FFP: ___________
CS HQ Contact Information                  CS Country Office Contact Information
(including Name/Title, Address, Telephone,       (including Name/Title, Address, Telephone,
Fax, E-mail)                                     Fax, E-mail)
                                                    Table of Contents

A.    Executive Summary
B.    Problem Analysis and Proposed Interventions
C.    Program Objectives and Design
D.    Complementarity
E.    Detailed Implementation Schedule
F.    Monitoring and Evaluation
G.    Commodity Market Issues
H.    Audits
I.    Activity Resource Requirements
J.    Waiver Requirements
K.    Initial Environmental Examination
L.    Certification Regarding Lobbying
M.    Certification Regarding Terrorist Financing
N.    Agreements, Contracts, Letters


1.    Executive Summary Tables
2.    Budgets
              2.1 Comprehensive Budget
              2.2 Detailed Budget
              2.3 Negotiated Indirect Cost Rate Agreement
3.    Annual Estimate of Requirements – Pls use electronic format
4.    Initial Environmental Examination
5.    Certification Regarding Lobbying
6.    Certification Regarding Terrorist Financing
7.    Agreements
8.    Bellmon Analysis
9.    Mission Vehicle Procurement Policy
10.   Country/Intervention Area Map
A. 	Executive Summary (1 page,)

Provide a concise summary of: 1) food security problem to be addressed; 2) strategic objectives and expected results; 3) the proposed program
activities; 4) reason for requesting Title II commodities; 5) resources required and committed, both in-kind and dollars (or dollar equivalent), from all
sources; and 6) how the results will be measured and monitored. Briefly present the history of CS activities in the country or region, including the
evolution of the Title II strategy and proposed interventions. If there is an emergency relief context, discuss how the proposed programs incorporates
development-relief concepts to address transitory and chronic food insecurity, if applicable.

The tables associated with the Executive Summary have been moved to the Annex A, Executive Summary Tables. This annex includes many of the
required tables and instructions for their submissions. The website is: (LINK TO BE ADDED)

B. 	Problem Analysis and Proposed Interventions (up to 3 pages if one objective; up to 6 pages if two or more objectives)

The same level of problem analysis is required for all Multi-Year Assistance Program proposals, whether a follow-on to a previously approved
proposal or a completely new proposal. If a Multi-Year Assistance Program proposal is integrated with Mission activities and points 1&2 below are
covered in the Mission Plan, this plan may simply be referenced.

   1.	 Provide a brief description and analysis of the critical food security problems facing the population in the country and the proposed target
       area. In this analysis, include or reference appropriate national and local level data that is available on the degree of food insecurity; major
       determinants of food insecurity (including infectious or water-borne diseases, geo-climatic conditions, natural resource constraints, political
       and socio-economic conditions, etc.), and the linkage between these factors. Provide data on the geographic distribution of food insecurity in
       the country to justify the choice of geographic area(s) targeted. Note: Priority for programs in sub-Saharan Africa and South Asia will be
       reflected in the Congressional Budget Justification (CBJ) country allocations determined by FFP. The Congressional Budget Justification is
       the annual budget submitted by the Agency to Congress in support of all required expenditures.

   2.	 Based on this analysis of food insecurity problems, identify the priority technical and geographic areas where development assistance is
       needed, and the time line for action. Briefly describe the extent to which problems in these priority areas are addressed by USAID/DCHA,
       Global, Mission, World Bank, World Food Program, or other development and community organizations. Note which unmet development
       needs remain.

   3. 	 Among these unmet needs, describe the capacity and relative strengths in your organization for addressing them, technically and
        geographically. Include a statement regarding the institutional capacity of your organization, and of local partners (if relevant), and the basis
       upon which this assessment is made.

   4. 	 Based on the analysis of unmet needs and identification of your organization’s relative capacity to address them, briefly identify the technical
        and geographic areas that this proposed activity plans to address (detailed description should be deferred until section C.2.). All Multi-Year
        Assistance Programs should address problems of food access, availability, and/or utilization, with priority placed on activities that reducing
        risk and vulnerability to protect and enhance human capacities, livelihood capabilities, community resilience, and community capacity to
        influence factors that affect its food security. FFP places priority on Title II programming in populations with high levels of child
        malnutrition and poverty. Therefore FFP anticipates that the Food Aid and Food Security Policy Paper priority technical areas of household
        nutrition and agricultural productivity will continue to be a central focus of most Title II multi-year programs. For further technical
        explanation CSs should refer to the USAID Food Aid and Food Security Policy Paper at: (LINK TO BE ADDED) and the FFP FY 2005 –
        2008 Strategic Plan (LINK?). Reference a country/intervention area map as (and attach as “Appendix 10”) that clearly defines the area(s)
        of intervention.

       Food security programs with HIV/AIDS-affected populations may be supported by Title II resources, where it is determined that HIV/AIDS
       represents a critical constraint to household food security. The impact of HIV/AIDS on household food security and how the proposed
       activities would mitigate that impact should be described. CSs are encouraged to integrate HIV/AIDS activities and service providers funded
       by other sources (CS, USAID/Mission, etc.) with the Title II-funded activities. Where possible, direct co-programming of resources (CS,
       USAID/Mission, etc.) should be undertaken.

C. 	Program Objectives and Design (up to 15 pages if one objective, up to 20 pages if two or more objectives)

       C.1. Specific Objectives

       The MYAP proposal should prioritize program objectives, keeping them focused and limited in number and in context with the new FFP
       strategy framework. The objectives and related activities should be categorized under one of the following technical sectors:

       (a)   health and nutrition;
       (b)   agriculture, natural resource management and related infrastructure;
       (c)   education;
       (d)   micro-enterprise development;
       (e)   community capacity strenthening
       (f)   non-emergency humanitarian assistance; and
(g) emergency humanitarian assistance

Productive safety-net activities should be reflected under the relevant technical sector they support. Social safety-net acticities should
continue to be reflected under (f) non-emergency humanitarian assistance. Clearly state the objectives and intermediate results anticipated
over the life of the program. State the established timeframe for completion.

C.2. Proposed Activities

Describe the type, purpose, location, and feasibility of the activities, referring to a country/intervention area map to be included as Appendix
10. Relate activities to the specific objectives and technical sectors. Describe how the activities will be implemented and by whom. Describe
and quantify the target population, including what proportion of the area’s population will be covered under each objective. If the activities
are proposed in more than one technical sector, describe how and to what extent the interventions will be integrated at the community-level.
State the amount and type of commodity that would be used. Specify how the Title II food and/or monetization proceeds will be utilized, and
justify the size of the ration and the ration mix selected.

Gender issues are important considerations in the design, targeting, and management of the program components. Multi-Year Assistance
Program proposals should describe a gender strategy to ensure equitable participation by both men and women in Multi-Year Assistance
Program activities.

C.3. Key Assumptions and Risk Management

Discuss the key or critical assumptions of the planned activities and any risks that may negatively affect expected results. If relevant, include
climatic, political, or economic instability or potential for other program disruptions. If the proposal includes a monetization component,
include potential risks and typical problems associated with commodity trading (e.g., defaults by buyers, commercial sector complaints,
fluctuating market prices, and currency devaluation). Briefly describe any contingency plans to mitigate the risks and the effect of changes in
critical assumptions. If the success of the planned activities is contingent upon conditions or events outside the CS’s control (e.g., host
government infrastructure, policy or program shifts of the host government, or material contributions from other organizations), briefly note
them. State how they could affect the CS’s ability to carry out its planned activities and how the CS would address this situation.

C.4. Sustainability Strategy

Identify the exit strategy for Title II assistance. Describe a time frame for graduation of families from specific components, individual
communities from the Multi-Year Assistance Program, and the Multi-Year Assistance Program from the geographic area. Describe how the
       activity will promote the financial and/or institutional sustainability of intended results. Discuss how sustainability will be measured, e.g.,
       cost recovery, financial commitment, technical/managerial capacity, community commitment, or the capacity of host country counterparts,
       government, or institutions. If applicable, describe the capacity of host country counterparts to sustain the results of the activities. If the
       activities are not to be continued, explain why the activity will no longer be required.

       C.5. Lessons Learned

       If the CS had a previous Title II program in the target country, the activity design should incorporate lessons learned from previous activities
       and respond to the concerns raised in recent evaluations or audits. The design should also include lessons learned from other relevant country
       programs. If the program builds on non-Title II investments/activities in the area, outline these activities, their impact, and lessons learned for
       the current Multi-Year Assistance Program proposal design.

D. Complementarity (up to 1 page)

Briefly describe how program interventions support or complement host government (national, regional, or local), CS, and USAID/Mission strategic
development objectives. Describe how Title II activities relate to other investments that have occurred in the same geographic area, ether by the host
government, other CSs, USAID, or other donors. Note any complementarity between the proposed program and other relevant activities being
undertaken in the country. Indicate where complementary programs are being carried out. State how Title II resources are being integrated with
other resources. Describe partnerships and alliances with community and local groups, as well as with other CSs.

If collaboration with other CSs is anticipated, describe how resources are to be pooled and describe the relationships and responsibilities among the
group. If a consolidated country program or a consolidated regional program is being presented, discuss the complementarity between the programs.

E. General & Detailed Implementation Plans (up to 6 pages)

Provide a detailed, time-phased implementation plan for the first fiscal year of the Multi-Year Assistance Program that accurately reflects the
interaction of resources, activities and achievement of performance targets. As such, this plan should be regarded as a management tool that guides
and directs the annual implementation of the Multi-Year Assistance Program program. At a minimum this plan should include: a list or chart
identifying key activities planned; the quantity and timing of these activities; person(s) responsible; and the relationship between the planned
activities and the strategic objectives. Activities should be clearly linked to strategic objectives and specific performance targets. Indicators should
be identified that will be used to track progress in achieving annual targets and objectives. In addition to the technical program activities, all training,
technical assistance, evaluation, audit, commodity procurement, and other key support actions should be included in the activities list of the detailed
implementation plan. Additional narrative is encouraged to further describe the information provided in the chart to support linkages between
activities and expected achievements. If major assumptions are being made to support performance targets, these should be noted accordingly.

Provide a general time-phased implementation schedule for each of the Multi-Year Assistance Program out years. Include a list or chart identifying
the following: key activities planned; timing of these activities; person(s) responsible; and the relationship between the planned activities and the
strategic objectives, performance indicators, and/or benchmarks established for each activity. Include all training, technical assistance, evaluation,
audit, commodity procurement, and other key actions.

It is understood that as the implementation of programs evolve over time there will be changes and refinements to the general implementation plans
for the out-years. For this reason, FFP will request a detailed implementation plan for each program year as part of the resource request section of
the CSR4. This will ensure that the implementation plan remains relevant and incorporates lessons learned and feedback from monitoring and
evaluation exercises.

F. Monitoring and Evaluation (up to 4 pages)

       F.1. Monitoring and Evaluation Plan

       Describe the monitoring and evaluation (M&E) plan that will be implemented to measure the performance indicators and report on the degree
       of achievement of results. Joint monitoring and evaluation plans are encouraged where more than one CS is engaged in similar activities, and
       is required where a consolidated proposal is being submitted.

       The Multi-Year Assistance Program proposal should articulate a comprehensive and actionable methodology for monitoring and evaluation,
       including baseline data, (or a plan to complete the baseline data collection within the first year of the Multi-Year Assistance Program),
       measurable intermediate results, and procedures to collect, analyze, and incorporate results in modifying the activity based on lessons learned.
       A mid-term evaluation should be programmed approximately mid-way through the Multi-Year Assistance Program period. The mid-term
       evaluation should provide an assessment of progress in Multi-Year Assistance Program implementation that can serve as a management tool
       to refine program activities and improve internal CS management of the program. Emphasis should be placed upon the implementation
       process and effects at the beneficiary level. There is no requirement for a population-based survey at mid-term, only at the baseline and final
       impact evaluation. An external impact evaluation should be planned for the penultimate year of the Multi-Year Assistance Program. The
       focus of the final evaluation should be the results achieved by the program, substantiated with quantitative data from a population-based
       survey. The results of the final evaluation will be a primary consideration in the review of follow-on or similar Multi-Year Assistance
       Program proposals.
A viable Monitoring and Evaluation Plan should include the following:

   a. 	 For each indicator, clear identification of the type of data to be collected, the frequency of data collection, the methodology to be used,
        the population covered, key assumptions anticipated in the planned interpretation of data, and the personnel who will collect and
        analyze the data.

   b.	 Description of the information and data collection systems in place or planned that will be used to track progress related to annual
       monitoring indicators; description of how monitoring information will be used to adjust activity implementation.

   c.	 Description of the evaluation component of the activity planned for measuring progress related to impact indicators, including
       personnel and funding required; description of the evaluation design, including sampling plan and plans for control groups, if any;
       description of the sources of baseline data; and a time line for the baseline study (which should be completed within the first year), the
       mid-term evaluation, and an impact evaluation [The final evaluation for Multi-Year Assistance Programs that have a Life of Activity
       of four years or longer should be conducted in the penultimate year of the program. For three year Multi-Year Assistance Programs,
       the final evaluation should be conducted by the first quarter of the third year]; description of the monitoring procedure (technique,
       frequency) that will be used to measure behavioral change where behavioral change is sought.

   d.	 If required by the Initial Environmental Examination or Environmental Assessment, especially for activities in agriculture, natural
       resource management, water and sanitation, and/or physical infrastructure development, describe how the environmental impact will
       be monitored. Also, discuss whether the environmental effects will be part of the project's overall monitoring and evaluation system,
       and if so, whether annual and impact indicators have been developed.

F.2. Results, Performance Indicators and Targets

Performance indicators should measure the extent to which the activity results in changes in behavior and well-being at the population level,
as well as progress in activity implementation. Two types of performance indicators should be identified in the MYAP proposal: impact
indicators and annual monitoring indicators. CSs should refer to Annex F for a list of resources for additional information on indicators.

If the MYAP has Health and Nutrition program objectives, CSs are required to report on the impact on child nutritional status using indicators
of height-for-age and/or weight-for-age, in addition to indicators they may choose for changes in child feeding behavior. Where appropriate,
FFP also encourages the use of child nutritional status indicators, especially stunting (height-for-age), to measure the impact of activities in
other sectors.
If the MYAP has program objectives aimed at improving the food access component of food security (e.g.. program objectives in agriculture,
micro-enterprise development, income generation and diversification), CSs are required to report on the impact on household food
consumption using indicators of months of inadequate food provisioning and/or household dietary diversity.

Where appropriate, MYAPs should include annual monitoring indicators that provide information on the percent of targeted population
reached, the percent of targeted population adopting improved practices/behaviors, and the percent of communities with enhanced capacity.
The specific annual monitoring indicators will vary, based on MYAP-specific approaches and interventions.

Where appropriate, indicators and targets should be established to capture the impact of mitigation activities that lessen the negative impact of
a problem, such as a drought, cyclone, or a high prevalence of HIV/AIDS, on household food security of a particular target group. If possible,
CSs should work with USAID/Missions so that CS monitoring complements or supplements USAID monitoring and evaluation efforts, and

Where appropriate, the MYAP proposal should also identify the early warning indicators and trigger levels that will be used by the CS to
refine and adjust existing interventions to meet the increased needs, and/or initiate a request for emergency resources, to enable a timely
response to increased food insecurity following an emergency or shock.

Complete the performance indicator tracking table below with both annual monitoring and impact indicators and targets. Quantify the current
level of each performance indicator, if possible, with primary data (baseline) for the population of interest, or with secondary data that provide
a reasonable estimate of the current situation. Include annual targets as appropriate (not applicable as needed) and LOA targets for all
performance indicators. The magnitude of change in the performance indicator, the size of the population affected, and the criteria for
determining that targets have been achieved, must be clear.
                            Performance Indicator Tracking Table
                    Year Year Year 1* Year Year Year 2* Year Year Year 3* Year Year Year 4 Year Year Year 5* LOA LOA
 Indicator    Base 1*                            2* %Achie          3* %Achie    4* %Achie       5* %Achie
                          1* %Achie 2* Achie ved vs 3* Achie ved vs 4* Achie ved vs 5* Achie ved vs Targ Achie
              -line Targ Achie ved vs Targ ved Target Targ ved Target Targ ved Target Targ ved Target         et  ved
                                          et                     et           et            et
                     et   ved Target

Indicator 1
Indicator 2
Indicator 1
Indicator 2

Indicator 1
Indicator 2
Indicator 1
Indicator 2

 Note: Annual monitoring indicators should be reported on each year. Impact indicators need only be reported on those years determined by the
 CS as appropriate by the CS’s monitoring and evaluation plans. If the CS adjusts indicators or targets (for example, if found to be inappropriate
 or targets were set too high or low) clear explanation should be provided. Note that explicit FFP Approval is required for downward revision.
 * Specify the fiscal year to be reported (e.g. FY06).
G. Audits (up to ½ page)

Provide information regarding the CS’s A-133 audit policy/scheduling and other Title II-related
audit activities. Discuss how any outstanding audit recommendations will be closed and, as
required, incorporated into the activity.

H. Commodity Market Issues (up to 1 page)

       H.1. Bellmon Analysis

       State who carried out the Bellmon analysis and provide a brief statement regarding the
       summary conclusions, relevant issues or areas of concern, and plans to ensure they are
       mitigated or resolved. The CS should attach a copy of the analysis as “Appendix 8.”

       H.2. Usual Marketing Requirements

       The Usual Marketing Requirements (UMR) are detailed in the FFP Monetization Field
       Manual. Monetization activities will be undertaken only where they will not disrupt
       commercial markets for agricultural commodities. Program levels will be compared with
       USDA’s established amount available for US programming under the “usual marketing
       requirements” (UMR) analysis. The UMRs are routinely provided by USDA for specific
       commodities and countries. CSs are encouraged to get the UMRs from the USDA in
       Washington or through their Agriculture Attaches or USAID Mission locally. Where this
       is not possible, CSs may contact FFP.

I. Activity Resource Requirements (up to 5 pages)

       I.1. Commodities

       Programs in a single country should submit a single AER, commodity procurement
       schedule, and life-of-activity commodity requirement worksheet, in the electronic format
       in the Executive Summary Table. Consolidated regional program proposals should
       include an AER for each country, and reflect individual country data, as well as a
       consolidated total on the remaining charts.

           I.1.a. Annual Estimate of Requirements

           The CS should submit as “Appendix 3” the signed Annual Estimate of Requirements
           (AER) form for the first fiscal year of the Multi-Year Assistance Program. Ensure
           that package size and commodity type are specifically noted on the AER. The
           electronic AER can be found at: (LINK TO BE ADDED).

           I.1.b. Commodity Requirement Worksheet for Life of Activity
The commodity requirement worksheet must include all of the commodities for both
direct distribution and monetization required for program implementation for the
performance period of the Multi-Year Assistance Program. In addition, the
commodities must be attributed to either emergency or non-emergency programming.
A table must be completed for each year. This table should be completed in its
electronic format (found in the Executive Summary Tables), and submitted via e-mail
with the complete Multi-Year Assistance Program application. The commodity
requirement worksheet and instructions for its completion can be found at the site

See Annex A, Executive Summary Tables, for Commodity Requirement Worksheets
for Life of Activity (LINK TO BE ADDED).

I.1.c. Commodity Procurement Schedule

The commodity procurement schedule identifies which month the CS would like to 

have commodities to arrive at the U.S. port for the first year of the Multi-Year 

Assistance Program based on the invitation number. This table can be found at the 

website below and must be completed as part of the application process. 

See Annex A, Executive Summary Tables for Commodity Procurement Schedule

I.1.d. Monetization Plan

    Include a monetization plan as outlined in the relevant sections of the Title II
    Monetization Field Manual, referring to the monetization criteria and FFP
    monetization policies. Provide full justification for the monetization and describe
    the proposed mechanics of the monetization (type of sale, type of buyer,
    anticipated commodities, whether sale will be conducted with other CSs, etc.).
    Provide a separate monetization sales budget and projected proceeds from sales.
    Discuss sales proceeds management, including “maintenance of value” issues,
    and the vehicle procurement plan, if applicable. Reference the Title II Program
    Policies and Proposal Guidelines, Section VIII.c.iv.

    Anticipated Monetization Cost Recovery Calculation and Estimate

    Discuss anticipated cost recovery for the first fiscal year of the program.
    Compare against actual cost recovery achieved in prior year (if a follow-on
    program). Justify the monetization on the basis of the amount of funding to be
    made available for programming, as compared to the costs incurred in carrying
    out the monetization. Justify based on the generation and use of monetization
    proceeds and food security impacts. Discuss how previously encountered
problems will be avoided or mitigated and provide details on any localized market
factors that impact market prices and cost recovery.
              Anticipated Monetization Cost Recovery

              Complete the worksheet below (add or delete columns, as needed) for expected
              monetization transactions in the first fiscal year of the program.

                                                  Sale 1       Sale 2      Sale 3    Wtd Avg
1. Call Forward Number                                                               n.a.
2. Expected Sale Date                                                                n.a.

3. Commodity                                                                         n.a.

4. Tonnage to be Called Forward (total MT)                                           (total)

5. Exchange Rate (estimated)

6. CS estimated FAS cost (total $/MT)

7. Freight estimate (foreign flag)* ($/MT)

8. Inland freight estimate ($/MT)

9. C&F total cost est. using foreign flag

10. Anticipated sales price ($/MT)

Note: Use exchange rate applicable at time of estimate; FAS=free alongside ship,
C&F=commodity and freight

          I.1.e. Logistics Plan

          Discuss any commodity-related issues, including port facility, storage infrastructure,
          port management capabilities, transport status, and commodity pipeline. For
          landlocked countries, note the points of entry (limited to four) for FFP review and
          approval. For special procurement or shipping requests, such as containerization or
          through bills of lading for non-landlocked countries, a detailed justification must be
          attached. If reimbursement for inland transport charges will be requested, attach a
          copy of the
          contract covering transport for the first fiscal year of the Multi-Year Assistance
          Program, and an estimate of total U.S. dollars needed for inland transport. If not yet
          available, state when this will be submitted to DCHA/FFP. If the subject contract is
          not in English, a translation of the contract into English is required.

       I.2. Financial Plan
I.2.a. Budget Narrative

Explain how the financial requirements (in-kind, dollars, foreign/local currency for
the life of the Multi-Year Assistance Program program) will be met. If 202(e),
monetization, ITSH or other funds are expected to be carried over from the previous
fiscal year(s), explain why. Provide a budget narrative(s) to cover monetization,
Section 202(e) and ITSH) funds. Describe any budget line items or funding sources
that are not self-explanatory.
          I.2.b. Budgets

          Attach as “Appendix 2.1” the comprehensive budget format summarized by technical
          area for each fiscal year and total life-of-activity with the appropriate attribution to
          emergency or non-emergency programming.

          Attach as “Appendix 2.2” the detailed monetization, Section 202(e) and ITSH, for
          each year of the Multi-Year Assistance Program, based on line item categories (e.g.,
          salaries, transportation, capital equipment, etc.). A detailed budget will be requested
          for each subsequent year of the Multi-Year Assistance Program with the Resource
          Request of the CSR4.

          I.2.c. Indirect Costs

          Attach as “Appendix 2.3” a copy of the latest approved negotiated indirect cost rate
          agreement (NICRA). For a CS that does not have a provisional or final approved
          federal rate, submit supporting documentation in the calculation of the CS’s indirect
          cost (overhead) rate(s).

       I.3. Human Resources (up to 1 page)

       Provide an organizational chart identifying the position titles of CS staff and the amount
       of time that will be devoted to each proposed activity and corresponding responsibilities.
       List the recipient agencies (counterpart and/or collaborating organizations, both private
       and host government). If not described in the complementarity section of the original
       proposal, briefly outline their financial and management roles. If extensive technical
       assistance is being planned, explain the scope of the activity and the individual or
       organization responsible.

       Provide evidence of the organization’s technical, financial, and managerial capability to
       design, implement, and monitor the proposed activities (including the number and size of
       programs managed or proposed). Describe prior performance implementing food aid
       programs in the proposed country or other countries, if applicable. Describe the
       organization’s headquarters, in-country, or regional personnel’s plans to backstop the
       Multi-Year Assistance Program proposal. Explicitly address the types of capacity
       building that will take place within the CS or counterparts to increase the sustainability of
       results. Discuss how the use of Title II non-emergency resources complements the CS’s
       strategy for the particular country and/or region.

J. Approval of Non-U.S. Equipment

If procurement of non-U.S. equipment or vehicles is intended, state the source and/or origin
waiver request and provide a justification. For vehicles, state how many non-U.S. vehicles are
planned for purchase, from which funding source, and justify fully the proposed purchases and
the funding source. Attach as “Appendix 9.” a copy of the written USAID/Mission procurement
K. Initial Environmental Examination

Attach as “Appendix 4.” an Initial Environmental Evaluation (IEE). Although the document
will have to be cleared by the USAID Mission Director or his/her designee, this will not be
required when initially submitted. For consolidated country proposals, a single IEE that covers
all activities should be submitted. For consolidated regional proposals, an IEE should be
submitted for each country program.

L. Certification Regarding Lobbying

Lobbying certification is required; complete appropriate sections of Appendix 5 (see
M. Certification Regarding Terrorism

In accordance with Executive Order 13224 all applicants for USAID assistance are required to
certify that they do not provide material support or resources for terrorist acts. Before making
the award of a grant or cooperative agreement to a non-governmental organization the
certification attached in Appendix 6 must be completed.

N. Agreements, Contracts, Letters

Attach as “Appendix 7” a copy of the host country Food for Peace Agreement, which should
make reference to and incorporate or attach Regulation 11. Indicate whether there are
outstanding issues, such as: the adequacy of the current agreement; exemption from the payment
of taxes on Title II program commodities, material, and equipment; the continuation of tax
exemptions on distribution commodities; how taxes/fees/tariffs for monetization commodities
will be covered; and how the host country has cooperated with the CS in the implementation of
its programs in accordance with Regulation 11 (in the case of follow-on programs).

Also include memoranda of understanding, inland contracts, letters of support or agreements
with relevant parties, as appropriate. If a document is lengthy, attach a copy only to the primary
(“original”) unbound copy of the proposal to both the Mission and to FFP. Explain below if a
host country agreement is not yet signed, and provide a timetable for submission. Identify any
additional agreements planned but not yet executed.
                                          Appendix 5

                              Certification Regarding Lobbying Form

                       Authority and Statutory Lobbying Restrictions

CSs are reminded that statutory lobbying restrictions and reporting requirements apply to Title
II donations to CSs. The requirements of 31 U.S.C. 1352 are that no appropriated funds can be
used to influence or attempt to influence an officer or employee of any agency, a member of
Congress, an officer or employee of Congress, or an employee of a member of Congress to
receive a federal contract, grant, cooperative agreement or a commitment providing for the
United States to insure or guarantee a loan. CSs are required to submit a Certification
Regarding Lobbying form with each annual submission (OP, Multi-Year Assistance Program
Amendment, CSR4s) to certify compliance with these requirements.

Furthermore, if any funds other than Federal appropriated funds have been paid or will be paid
to any person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with a Title II award, a Disclosure Form to Report Lobbying should be
completed and submitted. The Inspector General is required by law to evaluate annually and
report on compliance. USAID regulations concerning implementation of lobbying restrictions
are in 22 CFR 227, which appears in the Automated Directives System (ADS) 200.
                                Certification Regarding Lobbying Form

Submitted in connection with submission of proposal initiating USAID/BHR/FFP consideration
of P.L. 480 Title II grant request including any or all of the following: commodities; ocean
freight; inland freight; internal transportation; storage and handling; Section 202(e); Institutional

The undersigned certifies, to the best of his or her knowledge and belief, that:

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
    undersigned, to any person for influencing or attempting to influence an officer or employee
    of any agency, a Member of Congress, an officer or employee of Congress, or an employee
    of a Member of Congress in connection with the awarding of any Federal contract, the
    making of any Federal grant, the making of any Federal loan, the entering into of any
    cooperative agreement, and the extension, continuation, renewal, amendment or modification
    of any Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any
    person for influencing or attempting to influence an officer or employee of any agency a
    Member of Congress, and officer or employee of Congress, or an employee of a Member of
    Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the
    undersigned shall complete and submit Standard Form LLL, ‘Disclosure of Lobbying
    Activities,” in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award
    documents for all subawards at all tiers (including subcontracts, subgrants, and contracts
    under grants, loans, and cooperative agreements) and that all subrecipients shall certify and
    disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for
making or entering into this transaction imposed by section 1352, Title 31, United States Code.
Any person who fails to file the required certification shall be subject to a civil penalty of not
less that $10,000 and not more than $100,000 for each such failure. By signature hereon, the
applicant/grantee certifies that the information contained herein is accurate, current, and
complete to the best of its knowledge and belief, and that the applicant/grantee is aware of the
penalty prescribed in 18 U.S.C. 1001 for making false statements in applications or proposals.
       Signature: _________________________________________
       Typed Name: _______________________________________
       Organization: ______________________________________
       Title: ______________________________________________
       Date: ______________________________________________
 If applicable, complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
                                13. Type of Payment:             2. Status of Federal Action:
1. Type of Federal Action:           (check all that apply):        a. bid/offer/application
___ a. contract                        a. Retainer                  b. initial award
    b. grant                           b. one-time fee              c. post-award
    c. cooperative                     c. commission
        agreement                      d. contingent fee
    d. loan                            e. deferred
    e. loan guarantee                  f. other:
    f. loan insurance                      __________

                                                               5. If Reporting Entity in No. 4
4. Name and Address of                                            is Subawardee, Enter Name
   Reporting Entity:                                              and address of Prime:
    ____ Prime
    ____ Subawardee
    Tier ____ if known:                                            Congressional District, if
    Congressional District, if                                     known:

                                                               8. Federal Action Number, if
7. Federal Program                                                known:
    CFDA Number, if
    applicable: __________

10. a. Name and Address of                                     11. Amount of Payment:
       Lobbying Entity                                         (check all
        (If individual, last                                       that applies):
        name, first name, MI):                                     ____ actual
             (attach                                               ____ planned 

             Continuation                                              $ ______________         

             Sheet(s) SF-LLL-A, 

             if necessary)

             b. Individuals


             (including address 

             if different from No. 

             10a) (Last name, 

             first, MI): 

                                                               14. Continuous Sheet(s) SF-
                                                                   LLL-A attached
                                                                   ____ yes ____ no
3. Report Type:                9. Award amount,if known:    15. Information requested
   a. Initial filling             $                         through this form is authorized
   b. Material change                                       by title 31 U.S.C. section 1352.
                                                            This disclosure of lobbying
   For Material Change Only:                                activities is a material
     Year _____ quarter                                     representation of fact upon
   _____                     12. Form of Payment (check all which reliance was placed by
      Date of last report        that applies):             the tier shown when this
   _______                       ___ a. cash                transaction was made of xxxxx
                                 ___ b. in-kind; specify:   lobby. This disclosure is
                                    nature____________      required pursuant to 31 U.S.C.
                                    value ____________      1352. This information will be
6. Federal                                                  reported to the Congress semi-
   Department/Agency                                        annually and will be available
                                                            for public inspection. Any
                                                            person who fails to file this
                                                            required disclosure shall be
                                                            subject to a civil penalty of not
                                                            less than $10,000 and not more
                                                            than $100,000 for each such


                                          Print Name


                                          Telephone No. _______________ Date
                                               Authorized for Local Reproduction Standard
Form - LLL
      Country/Cooperating Sponsor FY 06 - FY xx Multi-Year Assistance Program


Reporting Entity:
Page      of ____

*U.S. G.P.O 1990-260-708:00012
Standard Form - LLL-A
Authorized for Local Reproduction
       Country/Cooperating Sponsor FY 06 - FY xx Multi-Year Assistance Program

                                            Appendix 6

                         Certification Regarding Terrorist Financing

BACKGROUND: Section 2339A of Title 18 of the United States Code prohibits the provision of
material support or resources for terrorist acts. Section 2339B of Title 18 of the United States
Code prohibits the provision of material support or resources to designated foreign terrorist
organizations, and requires any U.S. financial institution that becomes aware that it has
possession of, or control over, any funds in which a designated foreign terrorist organization, or
its agent, has an interest, to retain possession of, or maintain control over, such funds and report
to the Secretary of the Treasury the existence of such funds.

Section 1189 of Title 8 of the United States Code (section 219 of the Immigration and
Nationality Act, as amended by P.L. 107-56) authorizes the Secretary of State to designate an
organization as a terrorist organization if the Secretary finds that the organization (1) is a foreign
organization, (2) engages in terrorist activity (as defined in section 212(a)(3)(B) of the
Immigration and Nationality Act) or terrorism (as defined in section 140(d)(2) of the Foreign
Relations Authorization Act, Fiscal Years 1988 and 1989 (22 U.S.C. § 2656f(d)(2)), or retains
the capability and intent to engage in terrorist activity or terrorism, and (3) the terrorist activity
or terrorism of the organization threatens the security of U.S. nationals or the national defense,
foreign relations, or economic interest of the United States.

Executive Order 12947, as amended by Executive Order 13099, designated 16 individuals and
entities that threaten to disrupt the Middle East peace process, and authorized the Secretary of
State, in coordination with the Secretary of the Treasury and the Attorney General, to designate
foreign individuals or entities that are found to have committed, or to pose a significant risk of
committing, acts of violence that have the purpose or effect of disrupting the Middle East peace
process, or to have provided support for or services in support of such acts of violence. The
Secretary of the Treasury is authorized to designate, in coordination with the Secretary of State
and the Attorney General, individuals or entities that are determined to be owned or controlled
by, or are acting for or on behalf of, designated individuals or entities. All property and interests
in property in the U.S. or in the possession or control of U.S. persons of designated individuals
and entities are blocked, and any transaction or dealing in blocked property or interests in the
U.S. or by U.S. persons is prohibited.

Executive Order 13224 designated 27 individuals and entities that have committed, threaten to
commit or support global acts of terrorism, and authorized the Secretary of State, in consultation
with the Secretary of the Treasury and Attorney General, to designate additional foreign
individuals and entities determined to have committed, or to pose a significant risk of
committing, acts of terrorism that threaten the security of U.S. nationals or the national security,
foreign policy, or economy of the United States, and authorized the Secretary of the Treasury, in
consultation with the Secretary of State and the Attorney General, to designate additional
      Country/Cooperating Sponsor FY 06 - FY xx Multi-Year Assistance Program

individuals or entities determined to provide support for or financial or other services to or in
support of such acts of terrorism or persons designated in or pursuant to the Order, or individuals
or entities that are owned or controlled by, act for or on behalf of, or are otherwise associated
with, certain individuals or entities that have been designated in or under the Order. All property
and interests in property of designated individuals or entities in the U.S. or in the possession or
control of U.S. persons are blocked, and any transaction or dealing in blocked property or
interests in the U.S. or by U.S. persons is prohibited.

OMB has approved the Agency's information collection request under the Paperwork Reduction
Act allowing USAID to require applicants for assistance to give a certification that they do not
support terrorism. The approval is in effect from the date of this notice, and expires upon the
earlier of incorporation of this AAPD into ADS 303 or December 31, 2005.

GUIDANCE: Before making the award of a grant or cooperative agreement to a non­
governmental organization, the Agreement Officer must obtain a certification from both U.S. and
non-U.S. organizations, substantially as follows:

                       Certification Regarding Terrorist Financing Form

“As a condition of entering into the referenced agreement, [name of organization] hereby
certifies that it has not provided and will not provide material support or resources to any
individual or entity that it knows, or has reason to know, is an individual or entity that advocates,
plans, sponsors, engages in, or has engaged in terrorist activity, including but not limited to the
individuals and entities listed in the Annex to Executive Order 13224 and other such individuals
and entities that may be later designated by the United States under any of the following
authorities: § 219 of the Immigration and Nationality Act, as amended (8U.S.C. § 1189), the
International Emergency Economic Powers Act (50 U.S.C. § 1701 et seq.), the National
Emergencies Act (50 U.S.C. § 1601 et seq.), or § 212(a)(3)(B) of the Immigration and
Nationality Act, as amended by the USA Patriot Act of 2001, Pub. L. 107-56 (October 26,
2001)(8 U.S.C. §1182). [Name of organization] further certifies that it will not provide material
support or resources to any individual or entity that it knows, or has reason to know, is acting as
an agent for any individual or entity that advocates, plans, sponsors, engages in, or has engaged
in, terrorist activity, or that has been so designated, or will immediately cease such support if an
entity is so designated after the date of the
referenced agreement.

For purposes of this certification, "material support and resources" includes currency or other
financial securities, financial services, lodging, training, safe houses, false documentation or
identification, communications equipment, facilities, weapons, lethal substances, explosives,
personnel, transportation, and other physical assets, except medicine or religious materials. For
purposes of this certification, "engage in terrorist activity" shall have the same meaning as in
section 212(a)(3)(B)(iv) of the Immigration and Nationality Act, as amended (8 U.S.C. §
      Country/Cooperating Sponsor FY 06 - FY xx Multi-Year Assistance Program

1182(a)(3)(B)(iv)). For purposes of this certification, “entity” means a partnership, association,
corporation, or other organization, group, or subgroup.

This certification is an express term and condition of the agreement and any violation of it shall
be grounds for unilateral termination of the agreement by USAID prior to the end of its term.”

Signature ___________________________________

Print Name _________________________________

Title _______________________________________

Telephone No. _______________ Date ___________

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